Evolução e desfecho da síndrome respiratória aguda grave por COVID-19 em gestantes e puérperas adolescentes em comparação com adultas

Abstract

The SARS-CoV-2 infection was declared a global public health emergency by the World Health Organization (WHO) in March 2020. The clinical manifestations of COVID-19 vary widely, and certain population groups are at higher risk for severe outcomes. Pregnancy and the puerperium are considered risk factors for worse disease progression, particularly in the second and third trimesters of pregnancy and the postpartum period. In contrast, children and adolescents tend to experience milder infections, with lower rates of hospitalization and mortality, except in cases associated with obesity or pre-existing comorbidities. However, adolescent pregnancies, often unplanned, are linked to poorer maternal outcomes due to factors such as low socioeconomic status, reduced educational attainment, and limited prenatal care coverage. In Brazil, adolescent births still account for a significant proportion of total deliveries. Given this context, the question arises as to whether younger maternal age is a risk or protective factor for the clinical progression of COVID-19 during pregnancy and the puerperium. The main objective of this study was to analyze differences in the clinical progression and outcomes of severe acute respiratory syndrome (SARS) due to COVID-19 among pregnant and postpartum women aged 10 to 19 years compared to those aged 20 to 34 years. This is a cross-sectional observational study using secondary data from the Brazilian Influenza Surveillance System (SIVEP-Gripe), including cases of SARS due to COVID-19 reported among pregnant and postpartum women from 2020 to October 27, 2023. Bivariate analyses and multiple logistic regressions were conducted to evaluate sociodemographic and clinical variables, vaccination status, and clinical outcomes. The results indicated that, within the gestational-puerperal cycle, adolescence was associated with lower clinical severity of COVID-19, with lower proportions of intensive care unit (ICU) admission, invasive mechanical ventilation, and death, even after adjusting for comorbidities, gestational trimester, vaccination status, race/ethnicity, and geographic region. Vaccination demonstrated a protective effect, while the presence of comorbidities, the second trimester of pregnancy, and the puerperium were associated with worse outcomes. Additionally, an integrative literature review was conducted, focusing on the clinical progression and outcomes of pregnant and postpartum women infected with SARS-CoV-2 compared to women outside the gestational-puerperal cycle. This review included 29 articles addressing the topic. The findings confirmed that pregnancy, in general, is considered a risk factor for COVID-19 progression, particularly in contexts with limited access to healthcare services and multiple clinical vulnerabilities. It is expected that the knowledge generated will contribute to the development of surveillance and obstetric care strategies in public health emergencies, with a focus on specific age subgroups.